Tuesday, January 31, 2012

In Afghan war, rate of post-injury survival rises

Army Spec. Bryce MacBride, wounded in Afghanistan in late 2010, waits in the hallway of a hospital at Bagram Airfield. (Linda Davidson — The Washington Post)
There has probably never been a war in which there has been as much on-the-job improvement in the care of the wounded than there has been in the United States’ war in Afghanistan. Of course, at 10 years and counting, there has been a lot of time for practice.
That truth is evident in a recent report by the Congressional Research Service, “Afghanistan Casualties: Military Forces and Civilians.” It sketches out the remarkable ability of military physicians and nurses to save the lives of grievously wounded troops.
Last year, 415 American men and women died in Afghanistan, while 5,159 were wounded and survived.
That ratio — 12.4 survivors for every fatality — marked a record high over the past decade. In fact, the ratio has been growing almost every year since 2001.
In 2007, the first year in which battlefield deaths in Afghanistan surpassed 100, there were only 6.4 survivors for every fatality. The ratio dipped slightly in 2008 but has increased ever since.
How much better are doctors, nurses, medics, corpsmen and technicians in this war than in previous ones?
That’s hard to answer with precision. Comparisons are tricky because the quality of medical care isn’t all that changes between conflicts. Indeed, the nature and hazards of combat can evolve during the course of a war.
For example, a study of military personnel killed in Iraq and Afghanistan in the second half of 2006 found that 76 percent of fatalities were caused by explosions. Earlier in the wars (2003-04), that “mechanism of injury” was responsible for 56 percent of deaths.
In previous wars, blast injuries accounted for less than 10 percent of battle injuries.
That said, there is plenty of evidence that troops wounded today have a far better chance of survival than ever before.
In 2006, approximately 9.8 percent of wounded service members died either on the battlefield or after leaving it in Afghanistan and Iraq. During the Vietnam War, that figure, the “case fatality rate,” was 16 percent. During World War II, it was 19 percent.
These days, if you make it to a hospital alive, your chances of surviving are extremely good.
During the first eight years of the wars in Iraq and Afghanistan, 4.6 percent of troops who got to the trauma bay of a hospital eventually died. (During the 2007 “surge” in Iraq, that number was 3.2 percent ). Furthermore, the number has stayed low even as the severity of injuries has worsened.
Many factors have produced this story of survival.
They include consistent use of body armor; fire-retardant uniforms; the timely application of tourniquets (every service member carries two); battlefield bandages loaded with clot-forming powder; the use of whole blood (or its equivalent in components) in resuscitating patients; less use of IV fluids on the battlefield and in helicopter evacuation; a strategy of many short operations (“damage-control surgery”) in treating victims of poly-trauma; the placement of neurosurgeons in forward hospitals; and the improvement that comes with experience and multiple deployments.
“None of these kids would have survived in the civilian world,” Col. Jay Johannigman, an Air Force surgeon, said in late 2010 at Bagram Air Base in Afghanistan after a weekly meeting in which doctors review what has happened to critically injured troops after they return to the United States.
“And we never would have saved them five years ago.”

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